Few glad tidings were brought over the Christmas period. Following a year of plentiful political failures, England’s third national lockdown marks its place as necessary, though disastrously late.
In their epiphanic style, the three wise men, Professor Chris Whitty, Sir Patrick Vallance, and Boris Johnson shut down the country amid fear of overwhelming National Health Service capacity – a measure to help safeguard healthcare services and curb the rate of infection, at the cost of education, mental health, and the economy, to name a few.
But a broader concern has underpinned England’s management of Covid-19 since the beginning of the pandemic – the choice of strategy. Global successes at controlling the Covid-19 pandemic are markedly skewed towards countries in the East Asia and Pacific region. In these countries, low case numbers and resumed economic activity have been attributed to the early decision to pursue a zero-Covid strategy – prioritising testing, effective contact tracing and supported isolation, strict border control, and clear public health messaging.
“Countries which have proactively and systematically pursued a zero-Covid strategy have kept their economies afloat.”
It is clear that England has favoured a seasonally recurrent influenza model that tolerates the circulation of SARS-CoV-2 in order to build, as Sir Patrick Vallance describes, “some immunity in the population”.
Needless to say, this is not a favourable nor acceptable response for a SARS-related virus capable of causing “long Covid” in around 10% of positive cases, and a syndrome in children resulting in widespread inflammation (MIS-C). In Sweden, where the country’s initial response allowed endemic spread of the virus in order to build up herd immunity, the failure has been clear.
Lockdowns are blunt and damaging instruments with a double-edge. On the one hand, they buy time for an effective response to be developed, but in doing so ripen the conditions necessary for further viral mutations and increase the risk of a virus spill-over event to occur.
Warning signs have already been issued with the emergence of highly transmissible variants, including B117 identified in the UK, and the mink-associated variant from Denmark, following spill-over from humans to animals.
Notably, spill-back can occur, where the reverse dynamic (human to animal transmission) is observed, importing new strains with the potential for sustained human-to-human transmission. These concerns compound support for the argument that maximum suppression – with a view to eliminate – is not only the clearest route to the end, it’s also one to avoid a new beginning.
WHO Executive Director, Dr Mike Ryan, distils the key leadership quality perfectly in the banal truism: “Speed trumps perfection. If speed is key, are we fighting a losing battle with a continual stream of delayed and reactionary responses?
There is, however, a glimmer of optimism to be found in the UK’s efficient regulatory approval and roll-out of vaccines. Providing vaccination is integrated as part of a wider strategic response compatible with the dynamics of SARS-CoV-2, the need for further harsh lockdowns can be avoided.
This has been and continues to be a pandemic of false dichotomies, with the most notable fallacy existing between public health and the economy. Cross-country economic evaluations consistently evidence that leaderships which have proactively and systematically pursued a zero-Covid strategy have kept their economies afloat, with several showing economic growth in the last fiscal quarter.
This lockdown can and must be the last. Suppression will help follow a focused effort to eliminate. Immediate actions must include rapidly scaling-up the Covid-19 vaccination programme, strengthening the find-test-trace-isolate-support infrastructure, and implementing stringent border control measures such as testing at airports and mandatory supported quarantine periods for travellers.
The government has mapped a route to follow yonder star, but it’s time they accept this to be the wrong path.
The Asia–Pacific region models to the western world that a zero-Covid strategy works and should be prioritised as a highly effective strategic response. Lives will depend on it.
Jay Patel is a Researcher at the Global Health Governance Programme, Usher Institute, University of Edinburgh.